My unit had been sent to bring a discharge from the hospital back to his house. There was much grumbling by myself and my partner leading up to this job because the patient weighed 250 pounds and his home had 15 steps, which meant that we would need to physically carry the patient up the two flights of stairs to his bedroom. My partner and I roll into the hospital, and of course, the nursing staff is nowhere near ready to discharge our patient (they never are), so we drop our stretcher to an appropriate height, take a seat, and wait.
When the nurse has decided that the patient can indeed leave, I walk into the room with her to introduce myself and meet the patient. I’m confronted with four women standing around a man sitting in a chair. One of the women introduces herself as the patient’s wife, but before she can finish the man in the chair interrupts with the air of someone who has spent a lifetime being in charge. He points at me and says “I know you!” I having never seen this man before in my life respond “Oh you do?” “Yes yes,” he says “you helped me out last week!” as I’m forming the word “No…” in my mouth, I look at the wife who gives me the motion indicating “just roll with it”. Yes, I say, I remember you, how are you doing? “Well, I’m doing just fine”. I step outside of the room to speak with the nurse and the wife, who tells me that my patient is 97 and has advanced dementia. She adds in that I should just humor him and make him feel important and he’d be happy.
So I do all my paperwork, speak to the wife about her house, and the best angle of approach to get the commander (my patient had been a commander in the Navy) home and in bed. During all of this, the commander is perfectly happy to sit back in his chair and observe the scene. “You know” he chimes in “this place is really run like shit. There’s no organization whatsoever. Everyone is always running around, they have no idea who comes and goes. This would not have passed in the Navy.” I couldn’t help but chuckle. His floor was very busy with discharges and new patients that night, and there were people everywhere.
We get the commander loaded and into his house. We have him seated on a piece of equipment called a stairchair, which is essentially just a metal chair with handles that’s used for carrying people up and down stairs. Before we can lift him up procedure says we need to strap him in with a strap over each shoulder and across his chest to keep him secured in the chair. “When you were in the Navy did you ever wear a jump harness?” “Of course, I did son” “Alright well I’m going to strap you into our chair here, and it’s going to be just like a jump harness, nice and tight to keep you attached to the equipment” “Well get on with it son”. He made a quip which I won’t repeat for the sake of decency about the straps being “looser than a…” compared to a jump harness.
Having strapped him into the chair we carry him upstairs. His wife who is watching from behind gets nervous as many people do, and the commander shouts “Now honey calm down and let these men work, this ain’t the most dangerous thing I’ve ever done”. Once we had him upstairs and settled in bed, his wife brought everyone a glass of water since it was a hot summer day and me and my partner were sweating. Before we could take a sip, the commander piped up:
“Now first I want to do a toast. I know toasting with water is bad luck, but to hell with it, never believed in luck anyway. Here’s to this beautiful life, the little bit I’ve got left, and what you guys have got in front of you.”
My job is not a fun one. Being a Transport EMT is the kind of job people do on their way to somewhere else. It takes a herculean effort for me to drag myself to work, especially those early morning shifts. There’s something devastating about working for a company that is at best ambivalent about your existence, for pay that’s hardly adequate, doing a job that requires you to take nice people to a facility they’re probably going to die in, and being pleasant and reasonable with people who will yell, scream, spit, and throw things at you.
Every time I step into an ambulance at work, I know that today I’m going to meet someone who want’s to live and is going to die. I’m going to meet someone who wants to die but is going to wither in a nursing home for years. I’ll deal with the ass-end of the healthcare profession and a lot of people who I’m not sure how they still have a job. This is the part of our healthcare system that doesn’t look like Grey’s Anatomy. The walls are dirty, the doctors are nowhere to be found, the nurses are at best burnt out and at worst apathetic, and nothing works the way it’s supposed to. Most people, doctors, nurses, EMTs, who are stuck in this part of the system are overworked, underpaid, and fighting a losing battle against things they cannot fix.
Sometimes, however, a glimmer of light shines through my days of lukewarm coffee and stuffy ambulance cabs. There’s a moment, just a moment, where I don’t hate myself for what happens at work. I meet people who give me perspective. I meet people who show me how not to be. I meet people who give me a funny anecdote. I meet people or find myself in situations that teach me a lesson. It’s these patients, family members, medical practitioners, who can make a twelve hour shift with mandatory OT worth is.
Towards the end of my shift, my dispatcher hops on the radio and tells my partner and I, we’re going to have one more job. Shit. Of course, because 12 hours isn’t enough. The job is a psych discharge from an ER going to an inpatient psychiatric facility an hour away. Just wonderful. Psych patients, especially the ones requiring in-patient care who need to travel by ambulance, are not typically the kind of people you want to spend an hour in an enclosed box with going on the 13th hour of your shift. That may sound harsh, but it’s true. I’ve had psych patients attempt to jump out of moving ambulances, swing at me, spit on me, and talk my ear off about government mind control chips. But it is what it is, this is my job, at least I’ll pick up an hour of time and a half.
We roll up to the ER, wander inside. The nurse hands me a stack of papers, which I absent-mindedly flip through while she signs my transfer sheet. The patient is a middle-aged male with a history of substance abuse, depression, and violence. Internally I groan at “history of violence”, I really don’t want to restrain anyone tonight. We head over to the room where our patient is, my partner and I introduce ourselves, and have the patient get himself situated on our stretcher. Seems like a mellow enough guy, kind of looks like one of my friend’s dad. A little bit of hope grows inside me, maybe this guy isn’t that bad.
We get in the truck, and I do my normal “do you want the lights on or off; do you want the AC on; do you want to sit up or lay back? Please keep your arms and legs inside the ambulance at all times, the Captain has turned on the no-smoking light” shtick. The patient is quiet, just stares out the back window for the first 15 minutes of the trip. All of a sudden he turns to me and asks “What kind of music do you listen to?” Caught off guard I say “Rock and country mostly”
“How about Johnny Cash?”
“I’ve been known to listen to Cash”
“Do you know the cover he did of 9 Inch Nails?”
“If you wouldn’t mind could you play it for me?”
I pull out my phone, dial up “Hurt by Johnny Cash” on YouTube. As he listens to the song, I see tears roll down his eyes. After the song ends, he apologized and started explaining how he ended up in the back of an ambulance being committed to a psych ward. He had dropped out of college, got married, and ended up owning a plumbing company with a friend of his, where he made ‘good money’. He had two kids. He told me his whole life story. His wife left him, and he hadn’t seen his kids in years. What was obvious to me, but what he was still in denial about was that he was an alcoholic. He maintained that he would just have a few drinks after work and his (ex)wife would always overreact, and they just had some fights that got “out of hand”. I’ve seen substance abuse before, but not this side of it. Never what happens after I drop off that drunk guy at the ER.
Alcohol has destroyed this man’s life. His wife lost a husband, his children lost a father, and he lost his family. Standing in the wreckage that used to be his life in a last attempt to take control, he tried to take his life. Now he was sitting in an ambulance crying to a 19-year-old EMT who was trying to pretend like he knew what to do. Choices have consequences, and before you know it you may hardly recognize yourself. Since that night I’ve never been able to listen to Hurt without thinking of him and his family. When we dropped him off, he shook my hand, wished me luck, and told me he’d look me up if he ever got better.
There’s one facility everyone hates, and my company, bless them, has a contract with this facility so we are in and out of there on a regular basis. This facility is a “Skilled Nursing Facility”, and I use “Skilled” in the loosest sense of the word. If you’ve ever seen a horror movie set in an old medical facility, this is basically that. The scent that hits you when you walk in is overwhelming, feces, disinfectant, and something I still can’t place that only exists in places like this. There are patients left in the hallways, moaning grabbing at us as we pass. The nursing staff is typically nowhere to be found, and when you finally track one down, they’re less than helpful. Many of them clearly do not care about their patients. This is just a job for them, they show up, do enough to get by, and leave. Others are just incompetent. I cannot imagine working in a place like this, let alone receiving “care” and living here. Neither can most people, so the long term residents at this facility are people who have nobody left to advocate for them, or people with no other option.
There are a few patients at this facility who are regulars for our company, meaning we take them to and from treatments (typically) dialysis three times a week. One such patient is a male with a host of problems, but he’s nice enough. I’d been taking him regularly for a few weeks, he’s typically quiet and looks sad, so I would leave him be during the transport. But today was different. It was a beautiful sunny day, and we took him outside. The sun hit his face, and I’d never seen him smile the way he did that day. On the drive back to this facility, he asked me if I liked NCIS the TV-Show. I don’t watch it regularly, but I know enough to hold up a conversation about it, so I said yes. We talked about NCIS the whole ride back (apparently, it was his favorite show), this was a man who I don’t think had ever said two words to me before.
When we pulled up to his Nursing Facility he asked ever so sheepishly if we could stay outside for a minute so he could enjoy the sun. We told him that we technically weren’t supposed to, and he could have his family or one of the nurses bring him outside. He quietly told us that his family didn’t come to visit anymore, and the nurses always told him no. Sounded completely plausible, so we sat outside with him for a few minutes. After that, we brought him inside and put him in bed. On our way out I asked him if he was going to be watching NCIS, he said he wanted to, but his TV wasn’t working. I did what I was supposed to do and I let the nurse know, who rolled his eyes, and said he would get around to that “someday”. So, I lied to my dispatcher to stall him, and I went back to the patient’s room. After some digging around, I found that his cable connection had fallen out the back of his TV. I popped it back in and just like that everything worked. I left him in his room beaming with the NCIS title sequence playing.
Most of my patients are elderly; I do however occasionally get the opportunity to work with life after it has just begun. I sometimes get kids, and occasionally even infants. The catch is none of these children are healthy by the time I interact with them. Their parents are going through what all parents dread: spending time in a NICU, PICU, or specialized children’s hospital. Some of these children have been abandoned by their parents, left as wards of the state. It’s a harrowing experience, in a lot of ways harder than dealing with adults.
Dispatched to a pediatric long-term care facility, to take a patient for evaluation by an outside physician. Get to the facility and start doing my paperwork and talking to the nurse, this patient as it turns out is on the upswing, and may be able to be discharged. I knew it was going to be a good day when I walk up to my patient’s bed to introduce myself and I get a high-five and a “hey dude”. This kid, bless his heart, was the most energetic ladies’ man I’ve ever met. The patient was 9 years old and a character. On the ride to his doctor’s appointment, he was picking my brain the way only 9-year old’s do. He’s particularly interested in how I do with the ladies. Asked if I have a girlfriend, and I showed him a picture of my girlfriend at the time. I get a “Nice dude! She’s a score!” and another high-five. He asked me all about my job, and how much training it took, and how much I get paid, and what’s the furthest I’ve gone in the ambulance, and what the buttons on the ambulance do, and what I’m writing on my paperwork, and everything else under the sun.
Dispatched to one of the hospitals my company has a contract with, to the NICU (Neonatal Intensive Care Unit), to bring an infant to a procedure at another hospital, parents would meet us at the destination. This baby was on her way to being discharged and sent home with her parents. In the back of the ambulance, the baby started crying. I really didn’t know what to do, I couldn’t remember the last time I’d interacted with a baby. I would assume sitting in a car seat next to some random guy in the back of a loud box probably wasn’t the most soothing experience for a newborn. I tried to “pet” her I guess? Calm her with my hand? Anyway, as soon as I touched her, she grasped onto my finger. I started humming amazing grace, I don’t know why really, I just did. She stopped crying and smiled. I’m almost certainly assigning too much significance to the acts of an infant, but that was a good day.
Folks reading this have probably caught on to the fact that I do not have the highest opinion of my sisters in scrubs, the collective nursing staff’s of the facilities I work with. I should clarify, I don’t hate nurses, I just feel strongly about bad nurses. That, I do run into a lot of great nurses, and one of the best pressure releases during a long can be joking with a nurse about our shared lot as unappreciated cogs in the machinery of modern medicine.
Nurse: Damn it, I forgot room 32 was going out today
Me: Don’t sweat it, I’m paid by the hour, don’t cost me nothing to sit here for a few minutes
Nurse: Ain’t that the truth, in that case, I think I’ll go on break, reconvene here in 30 minutes?
Me: Sounds good to me! I’ll go catch some shuteye
Or embracing the suck of the industry we’ve found ourselves in. This is an excerpt from a report I gave to an ER Nurse.
Nurse: What’ve you got?
Me: Fall victim, possible AMS from such and such nursing home
Nurse: AMS? When was the last time he was seen normal?
Me: Sometime in the past 72 hours
Nurse: *gives me an “are you f**king kidding me” look* [which is the only appropriate response to that statement]
Me: The nursing staff at the facility said someone may have seen him normal on Tuesday, but they’re not sure
Nurse: Great… I love that facility
Me: Oh yes it’s one of my favorites!
Nurse: So in what way is he altered?
Me: Well, he has a history of dementia, and I couldn’t get a straight story on what his baseline is… but he’s pretty in an out in terms of having a grasp on what’s happening
Nurse: *exasperated sigh* alright, thanks
Me: No problem
Little moments of professional humor can always make a shift go faster.
A common question that people ask me when they find out I’m an EMT is “What’s the worst thing you’ve ever seen?” It’s the public safety version of the infamous “Did you kill anyone?” question civilians ask of veterans. I don’t understand why people ask this question. If I walked up and asked “what’s the most terrible haunting thing you’ve ever seen?” to people I had just met, people would think I was a sociopath. But for certain professions, this is an acceptable conversation starter. I know what they want, some crazy story about a 10-car pileup, or a chemical spill, or anything involving drugs or alcohol. I’ve got a few of those, and I usually give the crowd what they want. Lay people lap that up for some reason. I don’t know why someone being really drunk and going to the hospital qualifies as an interesting story, but whatever. These things don’t bother me anymore, trauma’s, car accidents, OD’s, death, they don’t get my blood pumping the way they did when I first started. The honest answer to the question “what’s the worst thing you’ve ever seen” is despair. I don’t talk about it because that’s not what people want to hear, that’s not what they’re interested in. What keeps me up at night, what twists knots in my guts is the patient’s I’ve had who have given up. They’re alive, but they just don’t care anymore. People who are waiting to die. That’s the worst thing I’ve ever seen, and I see it regularly.
That’s my conclusion from all of this. You need something to live for. I realized at a point when I was nearing the end of my rope at work that I had more in common with a patient I was taking to hospice who had visibly given up on life than many of my peers. All of the patient’s who I admire, the ones I talk about above all had something in their life worth caring about, a reason for them to still be alive. The commander loved his wife and enjoyed telling his old war stories even if they’re the same ones over and over. My depressed patient still cared about his family more than himself, even if he hadn’t yet come to terms with his alcoholism and depression. My regular dialysis patient just wanted a few minutes of sunshine and to watch NCIS. If a man with no family left, living in an awful nursing home can be made that happy by a few minutes of sunshine, then me, an able-bodied college kid with a lot going for him can certainly find something worth caring about no matter how much I may dislike my job sometimes. Sometimes it’s something silly like taking a quality Instagram picture or getting an Oreo Frosty on my way home from work. Sometimes it’s something more wholesome like going far beyond what is expected of me for a patient or advocating for them when nobody else will. Either way, I’m trying to learn from these moments. I try to find the beauty in life, even if that means embracing the suck of wiping feces off my stretcher. I’ve found over the past years, that more than anything else (including coffee) I need those moments that remind me of the good in people, I need those moments that make me feel like me again.
In order to protect the privacy of my patients, coworkers, and medical facilities I work with, details have been altered or omitted from the anecdotes above. This included but is not limited to locations, transport times, gender, occupations, and diagnoses when not germane to the story. I have ensured there is no protected health information appearing anywhere in this post. Each anecdote while rooted in truth, and having an actual memory and person at its core, has been altered to the point calling it “based on a true story” would be more accurate. Any questions or concerns should be directed to [my first name]@[my last name].net